AB0490 PREVALENCE OF RISK FACTORS FOR CARDIOVASCULAR EVENTS, MALIGNANCY OR THROMBOEMBOLIC EVENTS IN RHEUMATOID ARTHRITIS UNDER JAK INHIBITORS IN A REAL-LIFE MONOCENTRIC COHORT
Authors: I. Giovannini, R. Agarinis, S. Cacioppo, S. Sacco, G. De Marchi, E. DI Poi, A. Zabotti, L. Quartuccio, S. De Vita
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Rheumatoid arthritis (RA) is an inflammatory, autoimmune disease, characterized by joint inflammation that can lead to irreversible joint damage and significant disability. The immunomodulatory therapies have dramatically changed the patient management, and the introduction of Janus kinase inhibitors (JAKi) leads the way to an oral, efficacious treatment for RA. Among JAKi, tofacitinib and baricitinib are considered as pan-JAKi (pJAKi) while upadacitinib and filgotinib as selective JAKi (sJAKi) drugs. However, recent safety issue has been highlighted, and the 2022 update of the EULAR recommendations for the management of RA suggests to consider the use of a JAKi only after risk assessment <sup>[1]</sup>. <h3>Objectives</h3> This study aims to describe a monocentric experience of JAKi treatment in RA patients in a real-life setting, focusing on the prevalence of emerging risk factors. <h3>Methods</h3> Patients diagnosed with RA according to 2010 ACR/EULAR criteria and treated in a routine clinical setting with JAKi were retrospectively recruited from our rheumatologic clinic from May 2017 to August 2022. We evaluated the risk assessment according to the 2022 update of the recommendation, as reported below, to describe a real-life experience in the use of JAKi. In details we evaluated: age (over 65 years), smoking status, cardiovascular risk factors (such as diabetes, obesity, hypertension), risk factors for malignancy (current or previous history of malignancy other than successfully treated non-melanoma skin cancer), risk factors for thromboembolic events (history of myocardial infarction or heart failure, cancer, inherited blood clotting disorders or a history of blood clots, as well as patients taking combined hormonal contraceptives or hormone replacement therapy, undergoing major surgery or immobile). <h3>Results</h3> 205 RA patients treated with JAKi were included in our study. 133 underwent pJAK treatment, and 77 underwent sJAK treatment. Overall, 167 JAKi treatments were started in female patients. 128 were positive for rheumatoid factor, and 102 for anti–citrullinated protein antibody. 96/205 JAKi treatments were started in patients over 65 (46,8%), 45 were smokers (22%), 76 presented cardiovascular risk factors (37%), 20 showed risk for malignancy (9,8%) and 21 for risk factors for thromboembolic events (10,2%). More details are reported in Table 1. At least 2 risk factors were reported in 30,7% of the population, and 11,7% presented at least 3 risk factors. <h3>Conclusion</h3> This study highlights the relative high prevalence of risk factors in a real-life population of RA patients treated with JAKi. The clinical effectiveness of JAKi has already been assessed by clinical trial and real-life experience, whereas the safety issue still remains to be further explored. Further studies are needed to define the RA sub-populations at highest risk for safety, and those patients who could benefit from an early JAKi treatment. <h3>References</h3> [1]Smolen JS et al. <i>Ann Rheum Dis</i>. 2023;82:3-18. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Ivan Giovannini Speakers bureau: not relevant for this type of study, Roberto Agarinis: None declared, Sofia Cacioppo: None declared, Stefania Sacco: None declared, Ginevra De Marchi: None declared, EMMA DI POI: None declared, Alen Zabotti Speakers bureau: not relevant for this type of study, Luca Quartuccio Speakers bureau: not relevant for this type of study, Salvatore De Vita Speakers bureau: not relevant for this type of study.